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Joslin Diabetes Center, a teaching and research affiliate of Harvard Medical School, is a one-of-a-kind institution on the front lines of the world epidemic of diabetes - leading the battle to conquer diabetes in all forms through cutting-edge research and innovative approaches to clinical care and education.

The Benefit of the Exercise Physiologist

Jackie Shahar, manager of the Exercise Physiology department at Joslin, works with patient James Dugan in the Joslin gym.

May is National Exercise Month. Throughout the month the Joslin Blog will be highlighting stories about exercising with diabetes. Be sure to check in each week for updates! This article was originally published on July 26, 2015.

Good nutrition without physical activity is like eating one-half of a really tasty sandwich. Although the half maybe nourishing and appealing, it isn’t fully satisfying. To achieve good health and excellent glycemic control you need both halves of the sandwich. Just as you may need a dietitian partner to help you maneuver the serpentine world of healthy eating, a guide in your exercise journey can be a lifesaver, also.

National Exercise Month is a good time to talk about the dietitian’s partner, the exercise physiologist (EP). Now most people are familiar with dietitians and have some idea of what they do and why seeing one would be a good idea if you have diabetes. However, determining why their doctor wrote out a referral for an appointment with an exercise physiologist may leave a lot of people scratching their heads.

Some people confuse exercise physiologists with physical therapists. Physical therapists help restore muscle and limb function after people have had an injury, but you don’t have to be injured to benefit from the services of an EP (such as Joslin’s own Manager of Exercise Physiology, Jackie Shahar M.Ed., R.C.E.P., C.D.E.,). Planning for and starting an exercise program can be challenging for many people with diabetes. EPs can help you learn how to exercise safely no matter what your starting condition is.

James lost nearly 50 pounds in half a year working with Jackie and the Why WAIT team at Joslin (Why WAIT is a 12-week motivational weight loss program offered at Joslin)

Excess weight, joint problems, diabetes complications such as retinopathy, neuropathy and nephropathy all require specialized techniques to make exercising safe. EPs have the anatomical training to be able to recommend exercises that will improve your cardiovascular and muscle strength without worsening your other medical condition(s).

The EP is trained to identify lifestyle-related issues that promote poor health and to design and implement a behavior-based treatment plan aimed at modifying those lifestyle behaviors. Lack of time and distaste are two of the reasons people give for not wanting to exercise. One of the EPs strength’s is the ability to match exercises to your lifestyle.

The EP will first analyze your current fitness level, and come up with a complete, individual exercise plan to improve your cardiovascular function and blood glucose control that takes into account your medical condition(s). Says Jackie– “For people with diabetes, an exercise physiologist is an excellent choice as a coach because he/she understands how exercise can affect blood glucose levels.“

According to Health Careers.org, the Board Certified Exercise Physiologist (EPC) is trained to:

Administer exercise stress tests in healthy and unhealthy populations

Evaluate a person’s overall health, with special attention to cardiovascular function and metabolism

EPs must have a degree in exercise physiology and/or has been certified by the American Society of Exercise Physiologists (ASEP).The coursework includes hard science courses such as Kinesiology (functional anatomy), biomechanics, exercise physiology, psychophysiology, cardiac rehabilitation, exercise testing and prescription, ECG interpretation, and statistics.

You might consider seeing an EP in the following circumstances

newly diagnosed with diabetes or pre-diabetes

trying to prevent diabetes

trying to lose weight or gain weight

seeking help in getting your blood glucose under control with exercise

trying to improve your aerobic capacity or increase muscle mass

diagnosed with other health conditions besides diabetes that will benefit from an exercise plan (e.g. high blood pressure, high cholesterol and high body fat)

Not every recognized diabetes education program has an exercise physiologist on staff. If your program doesn’t, ask your health care provider for a referral to an independent practitioner or check out the American College of Sports Medicine ProFinder website: http://certification.acsm.org/pro-finder

I am a writer assembling a book for the publisher JIST Career Solutions (www.jist.com). The book, the Occupational Outlook Handbook, is almost entirely based on public-domain materials from the U.S. Bureau of Labor Statistics. For photographs, however, I have had to turn to other sources. I wonder whether you would grant JIST permission to reprint the photograph at http://blog.joslin.org/2015/07/the-benefit-of-the-the-exercise-physiologist/, showing an exercise physiologist (Jackie Shahar) at work. Joslin Communications (and, if you desire, the photographer) would be given credit in the acknowledgments at the beginning of the book. Thank you.

Thanks for making the distinction between physiotherapists and physical therapist! I used to get them confused too, and I’m glad to hear that I wasn’t the only one. It’s great that there are people who work with those that haven’t experienced an injury but who still need assistance to get to a healthy place.